Last December, Lady Gaga bravely revealed that she has struggled with post traumatic stress disorder (PTSD) since she was sexually assaulted as a teenager. "I suffer from PTSD," she said in an interview. "I've never told anyone that before, so here we are. But the kindness that's been shown to me by doctors as well as my family and my friends—it's really saved my life." Since then, Lady Gaga has continued her work as an advocate for both sexual assault survivors and the mental health community—most recently through an honest letter she wrote revealing her day-to-day struggles with PTSD.

PTSD is a mental health condition impacting 8 million people each year. These people often develop the condition after experiencing or seeing a traumatic event, like a car crash, war, a natural disaster, or—in Lady Gaga's case—a sexual assault. Symptoms include having flashbacks or nightmares about the trauma, feeling triggered by similar situations, and feeling anxious—though they vary from person to person.

"I have wrestled for some time about when, how and if I should reveal my diagnosis of Post Traumatic Stress Disorder (PTSD)," Lady Gaga wrote in her letter. "After five years of searching for the answers to my chronic pain and the change I have felt in my brain, I am finally well enough to tell you. There is a lot of shame attached to mental illness, but it’s important that you know that there is hope and a chance for recovery." The singer revealed that each day she works to regulate her nervous system, because even mundane events—like "being touched by strangers who simply want to share their enthusiasm"—can trigger her. Lady Gaga also revealed that she experiences dissociation, which means she either has out-of-body experience or perceives her surroundings as not real. Not everyone with PTSD experiences dissociation, but it is common in one subtype of the condition.

"As my doctors have taught me, I cannot express my feelings because my pre-frontal cortex (the part of the brain that controls logical, orderly thought) is overridden by the amygdala (which stores emotional memory) and sends me into a fight or flight response," she wrote. "My body is in one place and my mind in another. It’s like the panic accelerator in my mind gets stuck and I am paralyzed with fear." Lady Gaga explained that when this happens, she falls into a depressive state and has trouble with regular activities like talking, performing, or taking a shower. She also tends to experience somatization, which means she experiences physical pain related to her mental state.

"But I am a strong and powerful woman who is aware of the love I have around me from my team, my family and friends, my doctors and from my incredible fans who I know will never give up on me," she wrote. "I will never give up on my dreams of art and music. I am continuing to learn how to transcend this because I know I can. If you relate to what I am sharing, please know that you can too."